Information provision and financial incentives in Catalonia's public primary care (2010–2019): an interrupted time series analysis

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2024-10-18 DOI:10.1016/j.lanepe.2024.101102

Roger Esteban-Fabró , Ermengol Coma , Eduardo Hermosilla , Leonardo Méndez-Boo , Carolina Guiriguet , Gabriel Facchini , Catia Nicodemo , Josep Vidal-Alaball

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引用次数: 0

Abstract

Background

The relative efficacy of information provision versus financial incentives in improving primary care quality remains a critical, unresolved question. We investigated these two strategies in Catalonia's public primary care system from 2010 to 2019: an innovative online platform providing real-time quality indicator information and targeted economic incentives for achieving indicator goals.

Methods

We conducted a comprehensive interrupted time series regression analysis on data from 272 primary care practices (5,628,080 patients). This analysis used linear regression models with Newey–West standard errors, and a sensitivity analysis including logit transformations to address ceiling effects. We evaluated 1) immediate post-intervention changes (step changes) in indicator results and inter-practice variability (coefficient of variation, CV), and 2) shifts in pre-intervention trends (slopes). We scrutinized 39 indicators after rigorous quality control: 23 novel (12 informed, 11 incentivized) and 16 derived from existing incentivized indicators. Robustness checks included 14 consistently incentivized and 10 non-intervened indicators. Overall, we assessed 63 indicators: 18 control, 13 follow-up, 9 quaternary prevention, 7 treatment, 7 diagnosis, 6 screening and 3 vaccination indicators.

Findings

Informed indicators showed positive impacts in 75% (9/12) of cases, and incentivized indicators in 64% (7/11) of cases. Incentivized indicators displayed improvements in annual trends ranging from 6.66 to 1.25 percentage points, with step changes up to 8.87 percentage points. Information led to step changes ranging from 19.67 to 1.07 percentage points, along with trend improvements between 1.09 and 0.34 percentage points annually. Both interventions were associated with step reductions in variability (up to −0.18 CV reduction) and significant trend improvements. Derived indicators showed limited improvements in results or variability (31%, 5/16), with minor step increases up to 2.22 percentage points.

Interpretation

Our findings reveal that information provision alone can match or even surpass the impact of financial incentives in improving care quality and reducing practice variability. This challenges conventional wisdom and offers a cost-effective, scalable approach to primary care quality enhancement, with far-reaching implications for global health policy.

Funding

European Union, Horizon Europe.

查看原文本刊更多论文

加泰罗尼亚公立初级医疗机构的信息提供与经济激励（2010-2019 年）：间断时间序列分析。

背景：在提高初级医疗质量方面，提供信息与经济激励的相对效果仍是一个关键的未决问题。我们研究了 2010 年至 2019 年加泰罗尼亚公共初级医疗系统的这两种策略：提供实时质量指标信息的创新型在线平台和实现指标目标的针对性经济激励措施：我们对来自 272 个初级医疗实践（5628080 名患者）的数据进行了全面的间断时间序列回归分析。该分析采用了带 Newey-West 标准误差的线性回归模型，并进行了包括对数变换在内的敏感性分析，以解决上限效应问题。我们评估了：1）干预后指标结果的即时变化（阶跃变化）和诊所间的变异性（变异系数，CV）；2）干预前趋势的变化（斜率）。我们对 39 个指标进行了严格的质量控制：23 个新指标（12 个知情指标、11 个激励指标）和 16 个源自现有激励指标的指标。稳健性检查包括 14 个一致的激励指标和 10 个非干预指标。总体而言，我们评估了 63 项指标：研究结果显示，知情指标对大多数国家产生了积极影响：在 75% 的案例（9/12）中，知情指标显示了积极影响，在 64% 的案例（7/11）中，激励指标显示了积极影响。激励指标显示年度趋势改善了 6.66 至 1.25 个百分点，阶跃变化高达 8.87 个百分点。信息导致的阶跃变化在 19.67 到 1.07 个百分点之间，每年的趋势改善在 1.09 到 0.34 个百分点之间。这两种干预措施都能使变异性逐级降低（最多可降低 -0.18 CV），并显著改善趋势。衍生指标在结果或变异性方面的改善有限（31%，5/16），小幅增加最多为 2.22 个百分点：我们的研究结果表明，在提高医疗质量和减少实践变异性方面，仅提供信息就能达到甚至超过经济激励的效果。这挑战了传统观念，为提高初级医疗质量提供了一种具有成本效益、可扩展的方法，对全球卫生政策具有深远影响：资金来源：欧盟，地平线欧洲。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.